How much does Medicare pay for CPT 91200?

Medicare allowed an average of $19.68 per service and paid $14.31 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $120.18, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 91200?

Measurement of liver stiffness. It was billed 47,567 times to 46,396 Medicare beneficiaries by 1,174 providers in 2024.

Does 91200 pay differently in an office than a hospital?

Yes. The allowed amount averaged $25.98 in an office setting and $9.88 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 91200 most?

Gastroenterology, with 23,975 services from 654 clinicians. Next are Nurse Practitioner, Physician Assistant, Internal Medicine.

CPT 91200

Measurement of liver stiffness

$19.68Medicare-allowed amount per service, averaged across 47,567 services

Providers submitted

$120.18

Asking price, not received

Medicare allowed

$19.68

The fee schedule figure

Medicare paid

$14.31

Balance is patient coinsurance

Providers submitted an average of $120.18 for this code and Medicare allowed $19.68 — 6.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $14.31 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $25.98
Hospital / facility: $9.88

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 28,954 services were billed in an office setting and 18,613 in a facility.

Services: 47,567
Beneficiaries: 46,396
Providers billing it: 1,174
Total allowed: $936,119

What Medicare pays for CPT 91200

Across 47,567 services billed by 1,174 providers to 46,396 beneficiaries, Medicare allowed an average of $19.68 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 91200

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	23,975	23,367	$21.47	654
Nurse Practitioner	9,450	9,314	$15.38	218
Physician Assistant	4,774	4,685	$17.54	120
Internal Medicine	4,765	4,482	$20.10	72
Diagnostic Radiology	3,550	3,527	$21.48	76
Endocrinology	219	213	$29.04	7
Undefined Physician type	167	166	$10.47	4
Family Practice	149	129	$21.58	6
Infectious Disease	122	121	$20.73	4
Hematology	89	86	$18.18	2
Pulmonary Disease	85	85	$10.98	1
Hospitalist	67	67	$17.32	2
General Surgery	39	39	$24.29	2
Hematopoietic Cell Transplantation and Cellular Therapy	30	30	$10.36	1
Pediatric Medicine	22	22	$9.92	1

91200 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	5,781	$23.61	$15.07	155
Florida	4,271	$24.98	$18.05	68
New York	4,102	$24.26	$15.72	90
Texas	3,990	$23.70	$17.62	107
Massachusetts	2,319	$14.39	$9.50	38
Ohio	2,119	$14.64	$11.33	48
Tennessee	2,096	$23.91	$18.19	15
Illinois	2,022	$17.75	$12.69	54
Virginia	1,677	$14.43	$10.29	40
Pennsylvania	1,511	$19.55	$14.55	49
Indiana	1,433	$17.11	$12.88	24
Missouri	1,109	$15.12	$10.88	26
Arizona	1,101	$13.69	$9.88	24
New Jersey	1,083	$20.85	$14.01	25
North Carolina	984	$17.98	$13.81	38
Mississippi	894	$21.05	$16.25	33
Washington	848	$21.06	$14.58	23
Louisiana	832	$18.07	$14.51	31
Michigan	807	$12.91	$9.36	23
Utah	781	$13.15	$9.67	11
Minnesota	656	$14.82	$9.82	16
Kentucky	647	$9.95	$7.59	16
Connecticut	565	$23.11	$15.26	16
Wisconsin	533	$13.73	$10.15	23
Colorado	480	$20.86	$15.01	21
Georgia	397	$17.90	$13.49	15
Iowa	386	$15.16	$11.55	10
Maryland	340	$13.81	$9.48	8
Arkansas	334	$18.46	$14.81	12
New Hampshire	299	$13.55	$8.94	8
New Mexico	289	$10.46	$7.81	12
West Virginia	277	$13.66	$10.84	6
Oklahoma	253	$12.04	$8.89	10
Kansas	247	$18.43	$14.19	9
South Carolina	234	$13.57	$10.64	8
Nebraska	230	$20.16	$14.81	6
Oregon	198	$20.61	$14.05	6
South Dakota	184	$9.56	$6.94	7
Alabama	182	$12.46	$9.44	5
Rhode Island	169	$31.04	$21.23	3
North Dakota	152	$8.91	$6.70	6
Hawaii	151	$22.84	$16.43	6
Nevada	107	$23.01	$17.98	5
Alaska	106	$13.13	$6.33	3
Maine	104	$8.38	$6.10	3
Vermont	88	$8.62	$6.12	4
Wyoming	57	$28.71	$21.70	3
District of Columbia	49	$34.33	$23.07	1
Guam	48	$32.61	$17.36	2
Montana	28	$10.35	$7.19	1
Idaho	17	$9.66	$8.06	1

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.